Mortality after surgery for primary hyperparathyroidism: results from a nationwide cohort

Abstract

Background Contemporary patients with primary hyperparathyroidism are often diagnosed with mildly raised serum calcium levels. Previous studies have reported increased mortality in patients with primary hyperparathyroidism. This retrospective cohort study aimed to examine whether contemporary patients operated for primary hyperparathyroidism have higher mortality than the general population, and whether mortality in these patients is associated with serum calcium concentration, adenoma weight or multiglandular disease. Methods Patients from a Swedish national cohort consisting of patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery 2003–2013, were matched with population controls. The National Patient Register, the Swedish Cause of Death Register, and socioeconomic data were cross-linked. End of follow-up was 10 years after surgery, 31 December 2015, or emigration. Mortality was analysed by standardized mortality ratio, Kaplan–Meier survival estimates, and univariable and multivariable Cox regression. Multiple imputation by chained equations was performed on missing data. Results After exclusions, there were 5009 patients with primary hyperparathyroidism and 14 983 controls. Multivariable Cox regression analysis adjusted for age, sex, Charlson Co-morbidity Index, marital status, level of education, disposable income, and period of surgery showed lower mortality in patients than controls (hazard ratio (HR) 0.83, 95 per cent c.i. 0.75 to 0.92). In univariable Cox regression of mortality in patients, serum calcium concentration (mmoles per litre) was associated with mortality (HR 2.20, 1.53 to 3.16). This association remained in multivariable Cox regression after multiple imputation (HR 1.79, 1.19 to 2.70). Conclusion Mortality was not increased in patients operated for primary hyperparathyroidism compared with controls in a contemporary setting. Preoperative serum calcium concentration might, however, influence survival.

Residual risks of comorbidities after parathyroidectomy in a nationwide cohort of patients with primary hyperparathyroidism

“…These mechanisms of diabetes mellitus and hypertension overlap substantially with the effects of PHPT on cardiovascular diseases. It has been reported that parathyroid hormone may cause endothelial dysfunction by inducing reactive oxygen species and in ammatory signals [5,42]. Therefore, consistent with previous studies, risk of cardiovascular diseases can be exacerbated in patients with PHPT, who also have diabetes mellitus and hypertension.…”

“…In addition to epidemiology, the prognostic factors for mortality and cardiovascular outcomes are crucial for the management of PHPT. Previous studies have reported an increased risk of cardiovascular diseases, cerebrovascular diseases, and mortality in patients with PHPT [5,6]. The risks are reported to decrease after parathyroidectomy [7] but remain higher than those in the general population [5,8].…”

“…Previous studies have reported an increased risk of cardiovascular diseases, cerebrovascular diseases, and mortality in patients with PHPT [5,6]. The risks are reported to decrease after parathyroidectomy [7] but remain higher than those in the general population [5,8].…”

“…Therefore, it would be helpful to identify the contributing factors for major outcomes and actively manage patients at high risk for cardiovascular and cerebrovascular diseases, even after they undergo parathyroidectomy. However, only a few studies have reported the prognostic factors for outcomes in patients with PHPT who underwent parathyroidectomy [5].…”

Improved Mortality Outcomes in Primary Hyperparathyroidism: Significant Benefit of the Dedicated Indian PHPT Registry

“…Survival after parathyroidectomy has been recently reported from the US, UK, and Europe. [ 8 9 10 ] In these contemporary reports, the common finding is comparable mortality with respect to the general population. However, higher mortality rates in patients with symptomatic (associated with complications) or severe disease (serum calcium exceeding 10.8 mg/dl) have been reported even in these countries.…”